Serum enzymes and other laboratory tests in acute pancreatitis

Abstract

This review evaluates selective enzymes and blood tests available for the diagnosis and prognosis of acute pancreatitis. It is concluded that serum amylase and lipase measurements represent the best available diagnostic methods. Newer alternative assays still require careful evaluation.

Serum lipase should be the laboratory test of choice for suspected acute pancreatitis

“…Although these extrapancreatic elevations may on occasion be very high, many authors have suggested that a cut-off level of three times the ULN be used, thereby increasing the specificity of the enzymes for AP. [1,3,11] These data show that, in line with other published data, [5][6][7] lipase and amylase are both very specific laboratory tests for the diagnosis of AP when the suggested cut-off level is used.…”

“…It is well known that other intra-abdominal disorders, such as peptic ulcer perforation, mesenteric ischaemia and intestinal obstruction, may present with raised serum lipase/amylase values. [3,5,6,11] These elevations are usually mild (typically between one and two times the ULN). Although these extrapancreatic elevations may on occasion be very high, many authors have suggested that a cut-off level of three times the ULN be used, thereby increasing the specificity of the enzymes for AP.…”

Acute Biliary Pancreatitis

“…Currently, these new markers have limited clinical availability, but there is significant interest in better understanding markers of immune response and pancreatic injury because these could be valuable tools for reliably predicting the severity of acute pancreatitis and supplementing imaging modalities. [10], [11], [12] …”

Acute Pancreatitis: Presentation and Risk Assessment

“…However, the utility of these enzyme markers is complicated by significant limitations, including low sensitivity and specificity (Young 1989). In aggregate, there are many causes of elevated serum amylase levels, and amylase levels may only be moderately elevated or even normal in proven cases of acute pancreatitis of all degrees of severity (Clavien et al 1989).…”

“…While an amylase level of three times the upper limit of normal is often recommended to support a clinical diagnosis of acute pancreatitis, the magnitude of the observed hyperamylasemia has limited direct correlation with disease severity (Clavien et al 1989). Furthermore, after reaching a peak serum concentration, the subsequent return of amylase levels to previously normal levels does not necessarily correlate with resolution of clinical illness, limiting the value of serial measurements (Young 1989).…”